Dr Steven Craig on a life-changing Canadian Fellowship

It was 33C degrees when we flew out of Sydney, and -26C when we arrived in Calgary. We stepped out of the airport’s heavy double doors and our two-year-old daughter, shocked by the cold, screamed, “Bad Canada!” We ran back inside, tore open our bags and put on almost every item of clothing we had.

In 2018 I elected to take time away from my visiting medical officer (VMO) positions in New South Wales to undertake further education in two areas of particular interest, namely endocrine surgery and surgical education. These are also specialty ‘areas of need’ in the districts that I am employed. To further my education in these areas, I developed a comprehensive educational program in North America.

I was accepted to commence an American Association of Endocrine Surgeons (AAES) Fellowship at the University of Calgary under world-renowned endocrine surgeon Dr Janice Pasieka. The AAES Fellowship is merit-based and highly competitive, with only 25 Fellows selected for high-volume sites across the entire United States and Canada. This fellowship met the clinical component of my educational goals, and it further developed important academic skills in teaching and research.

Dr Steven Craig with Professor Janice Pasieka

After our first night in Canada, we scurried from the empty outdoor car park to the mall to buy clothes. (Only later did we realise that the ‘parkade’ signs we kept seeing were directing us to the underground heated carpark, where everyone else had parked.) That afternoon, in our ‘proper’ Canadian winter clothes, we had a snowball fight in the park opposite our apartment, and Canada was no longer ‘bad’.

A few days later, I was issued the regulation white lab coat with my name emblazoned on it, and I set off to start my American Association of Endocrine Surgeons Fellowship. Once I’d figured out that there was no ‘tea room’ (“Oooh the tea room?! Is the Queen coming or something?!”) and to look instead for the ‘doctors’ lounge’, things went smoothly, despite the lack of tea – and the terrible coffee.

My experiences – clinically, and in terms of research and teaching – were varied and valuable. The case volume was broad and covered the full spectrum of endocrine surgery, with consistently challenging and complex cases, befitting a major university hospital. There were regular clinics for general endocrine surgery, genetic endocrine conditions, and neuro-endocrine tumours, and I was fortunate to complete ancillary rotations through endocrine medicine, radiology and pathology. I gained valuable experience in retro-peritoneal adrenalectomy, the application of intraoperative PTH in primary and tertiary hyperparathyroidism, sternotomy for the management of goitres, and the surgical management of gastro-intestinal neuroendocrine tumours.

The family enjoying the Canadian winter.

My preceptors, Dr Janice Pasieka and Dr Adrian Harvey, were meticulous. Their interest in the intricacies and nuances of current endocrine surgery, and how it might be applied to practice, was impressive. It also appealed very much to my academic bent and to my love of the exquisiteness of endocrine surgery.

Fellows’ meetings were held every Monday at 7am, come snow or shine, often based around a current controversy in endocrine surgery that I would need to research, present, and defend. I was also immersed in the history of endocrine surgery (a favourite topic of Dr Pasieka), including founding figures and contributors, and how the specialty has evolved over the years.

Complementing my clinical experiences were some great research opportunities, mostly centred around my interest in thyroid cancer. Most valuable was my work in the lab of Dr Oliver Bathe, a translational surgical oncology researcher. Together, we developed a prognostic gene assay for thyroid cancer, which is currently being moved towards commercialisation. I was fortunate to present this work at the recent International Association of Endocrine Surgeons meeting in Krakow, Poland, winning the Dr Selwyn Taylor Award for best scientific presentation. I was also given opportunities to lead a number of scientific papers and book chapters and was supported by the Fellowship to attend conferences across North America.

Dr Steven Craig receives the Selwyn Taylor award from Professor Gerard Doherty of Harvard University.

Like Australia, Canada’s population is aging, multicultural, yet largely Anglo- Saxon, with similar first-world health issues, such as obesity. There are pockets of significant disadvantage, including among Indigenous people. Canada is both heavily urbanised (concentrated along the southern border) and dispersed, and many patients have to travel long distances for tertiary appointments.

Of course, in Australia, those patients usually show up. In Calgary, when there’s 80 centimetres of snow, and your condition isn’t life-threatening, you just stay home and skip your clinic appointment (if you haven’t already travelled south to Arizona for the winter). We were also often unable to discharge patients because of the snow, particularly if they lived in the Rockies.

It was interesting to work in an entirely public system. While the Canadian public health system is well-resourced, I felt perhaps the lack of a private comparison made it less efficient. Things are generally well-organised, but perhaps a little slower, and there seemed to be a lot of red-tape in the system: bureaucrats would decide, for example, who your secretary would be, not you.

Overall, our time in Calgary was lifechanging. The Fellowship delivered on its promise to build my clinical expertise, and allow for and support higher-level academic work.

As with most travel, our understanding of the world and how people live expanded too. Our girls are now among the most intrepid four- and six-year-olds we know. They’ve skied Canadian black runs, hiked through the woods carrying ‘bear spray’ and cut down our own real Christmas tree. My wife was just as adventurous and even more tenacious, completing a marathon while also carrying bear spray, and triumphing over wild kids on snowedin days, as well as on long summer days when the sun sets after 10pm and nobody could sleep.

We trick-or-treated, had a magical white Christmas and ate our body weight in ribs at the annual Calgary stampede. We left Calgary with heavy hearts, but with perhaps the best possible souvenir: our six-week-old baby with a Canadian passport.

Dr Steven Craig FRACS